Texas medical center keeps its focus on process improvement

The UT Southwestern Medical Center is on a roll. Last year, it expanded its presence in the fast-growing Dallas market by opening an $800 million hospital complex. It recently won designation from the National Cancer Institute as a comprehensive cancer center and opened new brain and bioinformatics institutes. Since 2008, Dr. Daniel Podolsky has led the $2.3 billion teaching institution, whose 13,800 employees serve about 92,000 hospitalized patients a year. Modern Healthcare Nashville bureau chief Beth Kutscher recently asked Podolsky about the strategy behind the academic medical center's recent moves. This is an edited transcript.

Modern Healthcare: What were your goals for building the new facility?

Dr. Daniel Podolsky: Building a whole new facility for inpatient care was in the context of a health system that was growing at a pace greater than the local market, and on relative terms, greater than most university-based health systems.

The facility we were using, the St. Paul University Hospital, was built nearly 60 years ago. It really did not have the capacity to support the technology that we saw as being an important part of the future of clinical care.

MH: What made you think technology was where your focus should be?

Podolsky: We went through every aspect of the hospital's function and asked the question: How can we make the care a better experience for our patients and support their families? In addition, we wanted to build a hospital that had in its DNA an opportunity to facilitate our missions of teaching and training students and residents and supporting clinical research. So we set out to design a facility which would be efficient in the need to incorporate new technologies in the future, and finally, in being wired that enabled us to approach in a rigorous way an assessment of quality and the implementation of process-improvement capabilities.

There are a number of innovative uses that have been incorporated into the hospital that both improve care and the quality of experience. For example, one that has proved extremely popular with our patients as well as our staff and faculty is a very large, high-definition medical Skype capability in every patient room.

Patients may have been referred by a primary-care doctor who is across the city or in another part of the state or another part of the country. (Those physicians) can be brought into the discussion with the team here when reviewing imaging findings and discussing potential treatment plans. It's created the ability of a spouse to say goodnight face to face with someone in the hospital or to join rounds, as it were, and ask the physician or the nurse a question when they can't be there in person. It's allowed us an efficiency of getting input from our colleagues who might not otherwise provide consultation until the end of the day, to get their input when they are across campus in an outpatient setting.

MH: Academic medical centers are very high-cost systems because of their training and research missions. Are there ways in which this new facility helps you meet some of the goals of value-based care?

Podolsky: It's certainly enormously more efficient than our old facility. Some of that's bricks-and-mortar stuff in terms of upgraded utilities and energy-efficient ways of constructing the building. But things like the (communications) technology I've just described do have a significant impact on the efficiency of care.

We have some of the same technology in all of our procedural spaces, especially the operating rooms. So surgeons operating who may come upon an unexpected finding can have access to the expertise of another surgical discipline as the procedure is proceeding. They can interact directly with our pathology department if appropriate when a procedure for removal of some sort of malignancy is underway. That higher-quality interaction among the professionals (brings) a higher degree of communication and a higher degree of efficiency. All of that helps us in a value-based world.

MH: You've been on a fundraising tear recently with a new brain institute and an institute for bioinformatics. How do you do it, especially coming off the tough years we've had economically?

Podolsky: We are fortunate to be in Dallas, where there is both a community with the means to support important institutions and a will to do so. We are not the only institution that benefits from that civic-mindedness and that generosity.

MH: How competitive is the Dallas market, and what's the niche that you've carved out for yourself?

Podolsky: There are a lot of excellent medical institutions in Dallas. But we are really the only academic medical center in the city, the only medical school and the only one with the kind of research footprint that is a couple of orders of magnitude beyond others in the city. Fifty percent of the doctors in this whole region received either their undergraduate medical education or their graduate medical education residency training or both here.

We are very substantially skewed toward more complex care. When we look at our case mix index, it's pretty high by any national benchmark with two-thirds of our inpatient care within the boundaries of tertiary and quaternary care. And I think that that's not only high for Dallas, but even compared to peer academic medical centers around the country.

MH: You're seeing a lot of consolidation in North Texas. What is your partnership strategy?

Podolsky: We have over the past few years developed some very important partnerships in the form of a network of community primary-care physicians. The network is called the UT Southwestern Community Affiliated Physicians. These are physicians who are not employed by us, but we contract with them right alongside our faculty and our facilities where they agree to make a real commitment to integration.

So their EMR is compatible with our EMR. They help develop our care pathways and also receive on a very regular basis significant amounts of data about their practice outcomes, their practice efficiency, the total cost of care for their patients and resource utilization.

That has been our most significant initiative as consolidation happens. Recognizing our strengths being in tertiary and quaternary care and being relatively smaller in primary care, we decided that rather than grow that foundation, we would partner with community physicians who are willing to sign on to that set of commitments.